2026 Chi Alpha Fall Retreat Liability Form

2026 Chi Alpha Retreat Liability
2026 Chi Alpha Fall Retreat ~ October 2 - 4, 2026
Spencer Lake Christian Center, PO Box 309, Waupaca, WI 54981~ joshua@chialpha.org ~ 920.312.3508
Please fill out the information on the appropriate form based on the age of the individual attending. Each adult participant should sign their own form. Signatures on this form are electronic and may be signed with a mouse or your finger on a tablet/phone.
Participant's Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact
Full Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Agreements to be signed
Agreement
AGREEMENT FOR ASSUMPTION OF RISK, RELEASE, HOLD HARMLESS, AND INDEMNITY AGREEMENT
I, the undersigned, agree to the Agreement For Assumption of Risk, Release, Hold Harmless and Indemnity Agreement
Printed Name

First NameLast Name
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
General Release and Assumption of Risk
I, the undersigned, agree to the General Release and Assumption of Risk
Should be Empty:

2026 Chi Alpha Retreat Liability